Dear MDACC Members:Happy New Year! I hope the beginning of the year has kicked off with energy and hope for a year of fulfillment. If you’ve made a resolution to contribute to the community or start volunteering remember your cardiovascular home - the Maryland Chapter. Complete this simple form to get involved in a committee - we meet a few times a year via Zoom and once in person in November at the MACCS meeting at Heart House. The connections and camaraderie are part of why we do what we do. As an example of our efforts - check out below the work by our Carrier Advisory Committee (CAC) Representative Darpan Banal, MD, FACC and the larger ACC CAC Committee. All detailed policy that helps our patients get the right care at the right time. Here’s to 2024!
Garima Sharma, MD, FACC
Governor, Maryland Chapter ACC
2023 ACC CAC ACTIVITIES:
Deletion of HCPCS Code G2066
The ACC advocated for CMS to implement national pricing for code G2066 (in the form of technical components (TC) to CPT codes 93297 and 93298) to provide payment stability for implantable loop recorder and insertable cardiac monitor remote monitoring services. CMS has since deleted G2066 and added refinement of existing CPT code 93297 and 93298 for interrogation device evaluations. CMS had created G2066 to report the TC of insertable cardiac monitor and implantable loop recorder remote interrogation in 2020 after 93299 was deleted. The 2024 Medicare Physician Fee Schedule (PFS) final rule now assigns TC to 93297 and 93298. Both 93297 and 93298 can be billed without modifiers to report the global service when a clinician/office performs both the professional and technical portion of remote interrogation. These codes can also be billed with the 26 modifier for the professional service only when the technical component is provided by another entity. In cases where another entity provides the technical component, the TC modifier will be billed for the technical portion only of the remote interrogation services. For more on 2024 Coding Changes Impacting Cardiology, click here.
Multi-jurisdictional CAC Meeting on Non-implantable RPM and RTM
On February 28, the Medicare Administrative Contractors (MACs) held a multi-jurisdictional Carrier Advisory Committee (CAC) meeting to obtain advice from CAC members and subject matter experts (SMEs) regarding the strength of published evidence on remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) for non-implantable devices and any compelling clinical data to assist in defining meaningful and measurable patient outcomes for Medicare beneficiaries. The MACs use the information gathered at the meeting to determine if a local coverage determination (LCD) should be developed. ACC recommended a few experts to the panel at the request of the MACs. SMEs across clinical specialties expressed support and discussed the benefits of non-implantable RPM and RTM. Additionally, there was acknowledgement of the need for more time to allow the data to mature to prove RPM and RTM efficacy. Post meeting, ACC submitted additional literature for the MACs to consider. As of today, no LCDs have been developed as a result of the meeting.
On May 25, CGS Administrators along with WPS Government Health Administrators, National Government Services, Noridian Healthcare Solutions, and Palmetto GBA, hosted a multi-jurisdictional Contractor Advisory Committee (CAC) meeting on non-invasive technology for coronary artery plaque analysis. ACC recommended a few experts to the panel at the request of the MACs. Key takeaways included clarifying the goal of atherosclerosis imaging-quantitative computed tomography (AI-QCT)/quantitative coronary plaque analysis (QCPA) software is to analyze plague analysis and not to predict ischemia, and that clinicians should adhere to guideline directed medical therapy for coronary CT and then add on AI-QCT/QCPA if additional plaque analysis is needed to better understand risk. Meeting details can be found here. The MACs have not posted any LCDs as a result of the meeting, and ACC will continue to monitor for any potential LCDs.
Final LCD Posted: PET Scan for Inflammation and Infection
In June, CGS posted the final LCD (L39521) for Positron Emission Tomography (PET) Scan for Inflammation and Infection. In February, the ACC and the American Society for Nuclear Cardiology provided feedback on four clinical topics addressed in the LCD: additional indications, cardiac sarcoidosis, infection of cardiovascular implantable devices, and vascular gratification. CGS has responded to our comments and made changes to the LCD to reflect most of the comments. This LCD took effect on 08/13/2023 for jurisdictions J15 (KY & OH). The final LCD can be found here and CGS’s response to comments can be found here.
Left Atrial Appendage Closure Shared Decision-Making Language
It came to ACC’s attention that Palmetto was denying coverage of LAAC when an interventional cardiologist provided the SDM. It has long been the societies’ interpretation that an interventional cardiologist or EP can perform the SDM as long as they are not the one implanting the device. ACC, HRS, and SCAI spoke with Palmetto. Palmetto then held a webinar; however, we still found a discrepancy in their slides/presentation. ACC continues to work closely with SCAI and HRS on this issue. We just sent a joint letter to CMS to request further outreach to clarify that a “non-interventional” cardiologist could be either a cardiac electrophysiologist or an interventional cardiologist who is part of the care team, but is not the implanting physician, and that either physician will fulfill the SDM requirement. We are continuing to work on this. Please let us know if your chapter is having any problems with LAAC coverage.
MD Chapter ACC Gathering at ACC.24
Join our informal gathering at ACC.24 - stop by for a drink and apps at the end of a day of education. When you arrive simply ask the staff to locate our tables. See you in Atlanta!
Date: April 6
Location: Vues Lobby Bar
Omni Atlanta Hotel Centennial Park
100 CNN Center, Atlanta, GA
MDACC SUPPORTS CHANGES IN PRIOR AUTHORIZATION
Bills in both the Maryland House of Delegates and Senate have been introduced to reform prior authorization and step-therapy. MDACC is supporting these reforms through letters, in-person testimony, and an email campaign to the membership. See below for more details.
RE: SUPPORT FOR SB 308 Health Insurance – Utilization Review – Revisions and
SB 515 Health Insurance – Step Therapy or Fail First Protocol – Revisions
These bills target the unnecessary denial of health care services by health insurers. Commonly known as prior authorization or step therapy, these practices often delay or deny medications and services that have received clinical consensus through stringent vetting and are published and updated regularly in medical journals and literature.
Time is critical for cardiovascular patients. The sooner a cardiologist can treat and monitor a
patient, the more likely the patient is to recover and thrive. Unfortunately, insurer prior authorization program denials in Maryland are rising.
Increasingly, cardiovascular professionals use point of care tools (ACC Practice Tools) and other technological resources (NCDR National Cardiovascular Data Registry) to access information that provides update information that guides treatment decisions and helps them provide timely care.
In 2021, an American Medical Association (AMA) survey revealed the following about the impact of prior authorization on physicians and patients:
Not only are these policies hurting patients, but they are hurting physicians, too.
The process to secure prior authorization is labor intensive, costly, and stressful. Surveys consistently reveal that undue administrative burden is a leading cause of physician burnout and depression.
Mid-Atlantic Women Cardiologists Seminar:
Renegotiation: Rethinking Your Next Contract
Date: March 13
Click here for additional information and registration.
Click on the graphic, or here, to listen to the podcast.
Click here to listen to the recording.